tbuckley/cabot-search huggingface dataset:
Abstract 12175: A Migrated External Iliac Stent - To Retrieve or Not to Retrieve
Authors: Shaitalya Vellanki, Padma Shenoy, Daivd Yamane
Journal: Circulation (2022)

Endovascular venous stenting has become a more favorable intervention for occlusive, symptomatic deep vein thromboses (DVTs), especially given its decreased complication rate and shorter recovery time than its predecessor, open venous bypass. Risks, however, still exist and can include stent fragmentation and dislodgement causing cardiopulmonary complications. A 57-year-old man with bilateral lower extremity DVTs status post left external ilio-femoral stent and inferior vena cava (IVC) filter placement presented with one month of atypical chest discomfort. CT chest showed migration of his 40cm iliac stent to the IVC and right atrium. Interventional radiology visualized both a patent stent and IVC, however, attempted endovascular removal from the distal margin failed with initial retrieval of fragments only. Other fragments subsequently embolized to the pulmonary and lower lobe arteries and right ventricles. Extraction of more distal fragments was deferred due to risks of structural damage, arrhythmias, and pulmonary vasculature perforation. Fragment analysis by pathology demonstrated evidence of clot, yet cardiothoracic surgical intervention was deferred.The patient continued to experience chest pain and underwent a repeat CT chest three months later that demonstrated the stent extending from the right atrial junction to the infrahepatic IVC. Fragmented portions of the filter in the right ventricle and multiple stent fragments retained in the right upper and bilateral lower pulmonary lobes remained as prior with no evidence of pulmonary embolism (PE), pericardial effusion, or tamponade. Although rare, stent removal complications can occur with increased risk of long-term sequelae. Stent fracturing and dislodgement can result in foreign bodies showering the pulmonary vasculature and cardiac chambers, ultimately placing patients at risk for arterial perforation or dissection, pulmonary hemorrhage, intracardiac damage, tamponade, PE, and chronic thromboembolic pulmonary hypertension (CTEPH). The consideration of such risks, in addition to early involvement of interdisciplinary teams and thorough risk-benefit discussions between patients and providers are essential when undergoing stent removal and related interventions.
Abstract 12197: Causes of Death in Patients With Symptomatic Peripheral Artery Disease After Lower Extremity Revascularization: Insights From Voyager Pad
Authors: Mario Enrico Canonico, Warren Capell, Sonia S Anand, Manesh R Patel, Eike Sebastian Debus, Mark Nehler, Connie Hess, Judith A Hsia, Eva Muehlhofer, Lloyd P Haskell, Scott D Berkowitz, Rupert Bauersachs, Marc P Bonaca
Journal: Circulation (2022)

Background: In trials of patients with coronary artery disease (CAD), unknown deaths (e.g. out of hospital) are often categorized as sudden/presumed cardiovascular (CV) based on observations that recurrent coronary events are a major cause of mortality. Such conventions are applied broadly to CV trials, including those in peripheral artery disease (PAD). Recent trials in patients selected on the basis symptomatic PAD, such as EUCLID trial, report that only ~1/3 have known CAD. Therefore, understanding the causes of death in patients in trials of symptomatic PAD may help elucidate whether different conventions should be considered. Hypothesis and Methods: VOYAGER PAD enrolled patients with symptomatic PAD after lower extremity revascularization. Source documents were collected for all deaths and cause was adjudicated by an independent blinded CEC using accepted CV trial conventions for those dying out of hospital. For this post-hoc analysis, source documents were re-reviewed to provide further details regarding specific causes of deaths. Results: 6564 patients were randomized and followed for a median of 28 months. A total of 637 deaths occurred, and of these, 35% were CV, 22% were unknown (e.g. out of hospital, sudden deaths), and 43% were non-CV. Of the CV deaths, 40% (14% of all deaths) were atherothrombotic (e.g. acute MI, stroke, PE), while 60% (21% of all deaths) were not atherothrombotic (e.g. heart failure, shock). Deaths due to cancer (17%) and infection (15%) were more frequent than atherothrombotic deaths. Conclusions: Patients recruited into trials for symptomatic PAD die of diverse causes. Atherothrombosis caused a minority of deaths, while heart failure, cancer, and infection are as or more frequent. These observations suggest that causes of death differ in populations selected on the basis of PAD versus CAD and that assumptions underlying categorization of deaths of unknown etiology should be carefully considered in these distinct populations.
Abstract 125: Kidney-specific Biomarkers For Predicting Acute Kidney Injury Following Cardiac Arrest
Authors: Noa Berlin, Rahul Pawar, Anne V Grossestreuer, Mahmoud S Issa, Jeremy Silverman, Aditya Shekhar, Andrew Cole, Xiaowen Liu, Lara L Roessler, Mathias Johan Holmberg, Michael Donnino, Ari Moskowitz
Journal: Circulation (2022)

Introduction: Acute kidney injury (AKI) is a common complication following cardiac arrest (CA) and is associated with poor outcomes. Early detection of AKI is crucial; serum creatinine (sCR) is the most commonly used indicator of AKI, despite low sensitivity and specificity for early detection of AKI. Hypothesis: Kidney-specific serum biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and cystatin-C could better predict post-CA AKI than sCR. Methods: Adult CA patients who had kidney-specific biomarkers of AKI collected shortly after return of spontaneous circulation (ROSC) as part of four randomized trials and one observational study were included. Patients with Kidney Disease Improving Global Outcome (KDIGO) stage III AKI or end-stage renal disease, or renal replacement therapy at the time of enrollment were excluded. The association between renal biomarker levels (sCR, NGAL, KIM-1, cystatin-C) shortly after ROSC and the development of KDIGO stage III AKI within 7 days of enrollment were assessed as well as their predictive value of future AKI development. Results: Of 155 patients, 46 (29.7%) developed stage III AKI within 7 days, and 98 (63.2%) died prior to hospital discharge. Patients who developed stage III AKI, compared to those who did not, had higher median levels of sCR (1.4 mg/dL [IQR: 1.2, 1.9] vs. 1.2 [IQR: 1.0, 1.5]; p=0.001), NGAL (868,208 pg/mL [IQR: 412,547.1, 1,341,597] vs. 298,928.3 [IQR: 170,786.6, 594,389.7], p&lt;0.001). and cystatin-C (1,649,202 pg/mL [IQR: 1,184,788, 2,440,583] vs. 1,132,955 [IQR: 795,323.7, 1,580,415]; p&lt;0.001). There was no difference in KIM-1 between groups (150.6 pg/mL [IQR: 150.8, 288.4] vs. 158.9 [IQR: 78.8, 284.7]; p=0.351). There was no significant difference between biomarkers in their ability to predict development of stage III AKI (NGAL AUC=0.75 [95%CI: 0.67-0.83], cystatin-C AUC=0.71 [95%CI: 0.62-0.79], KIM-1 AUC=0.55 [95%CI: 0.45-0.65], sCR AUC=0.67 [95%CI: 0.57-0.76], p&gt;0.05 for all). Both NGAL and cystatin-C performed better than KIM-1 (p&lt;0.01). Conclusion: In post-CA patients, sCR, NGAL, and cystatin-C (but not KIM-1) measured shortly after ROSC were higher in patients who subsequently developed AKI. No biomarker was statistically superior to sCR. Comparison was limited by the small number of patients who developed AKI.
Abstract 11067: Off-Heparin Implantation of Leadless Pacemaker, a Single Center Study
Authors: Ivan Mendoza, Dan Tran, Karina A Gonzalez Carta, Ivan Mendoza
Journal: Circulation (2022)

Introduction: Leadless pacing(LP) technology has been expanding in recent practice as an alternative to traditional pacing This technology is associated with reduce complications such as infection, dislodgment, and hardware burden. There has been recent reports on effusions with its implantation .Historically the manufacturer has recommend bolus of heparin or infusions We present the results and operative outcomes of patients who received a LP without initial heparinization or infusion from 2016 to 2021 at a single center. Objective We sought to describe the outcomes of LP implantation without the need of heparin administration. Methods: We report the clinical outcomes and operative findings of 200 patients who underwent LP implantation without initial heparin loading or infusions . An aggressive flushing strategy of the sheaths before and during the procedures was performed Data recorded include indication, ejection fraction (EF) R waves, capture thresholds, ventricular ectopy on deployment,recaptures, procedure times, and complications. Patients on chronic anticoagulation were excluded Results: A total of 200 patients were included , average age was 77 years and 20 (10%) had a reduced EF (&lt;40%) pre-procedure. The most common indications included complete AV block (97, 48.5%) and atrial fibrillation with slow ventricular response (76, 38%). All patients (100%) had successful establishment of ventricular pacing with no short-term complications postoperatively. Average R waves after deployment were 9.7 with average capture thresholds of 0.84 @ 0.24 Ventricular ectopy was seen for 134 (67%) of patients upon deployment with 62 (31%) patients requiring recaptures, and 29 (14.5%) requiring more than one recapture. There was no evidence of thrombus in the sheaths or implanting instruments . There were no embolic or thrombotic complications. Conclusions: LP implantation is highly effective and efficacious in establishing single-chamber ventricular pacing for a variety of conduction pathologies with minimal complications postoperatively. It appears that an aggressive flushing strategy of the implanting equipment &amp; sheaths is safe &amp; effective without the need of heparinization. Further studies will be require to validate this strategy
Abstract 11868: Design and Development of Automatic Extraction Transformation and Load (ETL) Process and Machine Learning for Echocardiography Data Extraction and Validation: Houston Methodist CVD Learning Health System Registry
Authors: BUDHADITYA BOSE, Sara A Butt, PAYAM POURNAZARI, Hassaan B Arshad, Charlie C Nicolas, Rakesh Gullapelli, Nwabunie Nwana, Zulqarnain Javed, Kershaw Patel, MOHAMMED A. C PASHA, Stephen H Little, NADEEN N FAZA, Stephen L Jones, MIGUEL A CAINZOS, DIRK H SOSTMAN, William A Zoghbi, Sherif Nagueh, NASIR KHURRAM
Journal: Circulation (2022)

Introduction: Echocardiogram is one of the most performed cardiac study usually stored in heterogenous non-standardized format and not readily available for analysis, resulting in barriers to improve phenotyping use in prospective electronic health medical record (EMR) based cardiovascular research initiatives. Methods: We extracted echocardiograms imaging report data for 73,986 patients in Houston Methodist Hospital between 1 st January 2016 to 31 st March 2021 to be merged with the ongoing prospective Houston Methodist CVD Learning Health System registry. Using Structured Query Language (SQL), we implemented Extraction, Transformation and Load (ETL) data pipeline to extract and label data for 7 commonly used echocardiogram parameters: diastolic function (DF), ejection fraction (EF), severities for mitral regurgitation (MR), mitral stenosis (MS), aortic regurgitation (AR), aortic stenosis (AS) and classification per gradient characteristics. Results: Successful ETL operations transformed &amp; loaded data for identified echocardiogram parameters into Data warehouse. A total of 37 labels for MR, MS, AR, AS, DF, AS classification along with distribution for EF were generated. Using random sample draw of 2% (n=1,352) of comparing classification results of program to study files, the SQL program was debugged iteratively 7 times for data quality validation with accuracy of 100% for manual validation. For a total of 73,986 latest echo reports, 3 machine learning models i.e. support vector machines, XGBoost and random forest classifier, were trained on 67% data to test accuracy of data labels over 33% remaining data. All models generated 100% accuracy for of data labelling using rule-based SQL. Conclusion: A well-built locally developed ETL data pipeline removes barriers to semantically annotate, integrate and accurately curate large scale untapped echocardiographic data with significant potential to scale and support clinical and research registries.
Abstract 11466: CBSCs Derived Extracellular Vesicles Modify the Immune Response After Cardiac Ischemic Injury to Enhance Repair
Authors: Yijun Yang, Jaslyn Johnson, Constantine D Troupes, Eric A Feldsott, Lindsay Kraus, Emily Megill, Deborah M Eaton, Tao Wang, Marcus Wagner, Lena Ma, Markus Wallner, Hajime KUBO, Tabito Kino, Remus M Berretta, Mohsin Khan, Raj Kishore, Steven R Houser, Sadia Mohsin
Journal: Circulation (2022)

Introduction: Few therapies have produced significant improvement in cardiac function after ischemic cardiac injury (ICI). The activation of local inflammatory responses is critical to cardiac repair after ICI. Our previous studies showed that cortical bone derived stem cells (CBSCs) possess can enhance repair after ICI. Beneficial effects of CBSCs appear to be mediated by paracrine factors including extracellular vesicles (EVs). This study explored if and how these EVs enhance cardiac repair by modulating the ICI immune response. Hypothesis: CBSCs derived extracellular vesicles (CBSC-EV) modulate immune response after ICI. Methods and Results: Both CBSCs and CBSC-EV were transplanted into mice after myocardial infarction (MI). CBSCs and CBSC-EV treated animals had better ICI repair compared with Saline, with reduced scar size, attenuated structural remodeling, improved cardiac function, and reduced cell apoptosis. These effects were linked to alteration of immune response. Plasma analysis of CBSCs and CBSC-EV treated animals showed significantly lower level of pro-inflammatory cytokines such as TNFα 24 hours after MI. CBSCs and CBSC-EV treatment induced significant polarization from CD86+ M1 macrophages towards CD206+ M2 macrophages phenotype 5 days post-MI, with subsequent reduction of CD8+ T cells and increase of CD4+ T cells, especially the FoxP3+ Treg population, from 7 days to 14 days post-MI. RNA sequencing analysis revealed that CBSC-EV contained a distinct transcriptome compared with endothelial progenitor cells and cardiosphere-derived cells. Gene Ontology analysis suggested the differentially expressed genes in CBSC-EV significantly enriched in immune cell receptor binding. MiR-182 and miR-183, which ranked top of the most significantly upregulated genes in CBSC-EV, attenuated M1 macrophage polarization after LPS treatment and promote CD25+ FoxP3+ Treg differentiation in vitro. Conclusions: CBSC-EV enhance cardiac repair by modulating the immune response after injury and highlight the molecular bases of into the beneficial effects of cell-free therapy after ICI.
Abstract 12157: 4d Flow Mri Demonstrates Hemodynamic Normalization After Coarctation Repair in Pediatric Patients
Authors: Haben Berhane, Labib Shahid, James Rice, Cynthia K Rigsby, Joshua D Robinson, Lindsay Griffin, Alejandro Roldan Alzate, Michael Markl
Journal: Circulation (2022)

Background: Coarctation of the aorta (COA) is a focal aortic narrowing, and intervention is required for patients with severe hemodynamic impairment. Following intervention, patients remain at risk for long-term re-coarctation. We used 4D flow MRI to assess aortic hemodynamics pre- and post- COA repair in children compared to age matched healthy controls. Methods: Aortic 4D flow MRI was performed in 5 pediatric COA patients (baseline age 6-14 yrs, 1F) pre- and post COA repair (4 native COA, 1 re-intervention) and 5 age-matched controls (ages 9-17 yrs, 2 female). Peak systolic velocities were quantified with velocity maximum intensity projections (MIP) ROIs in the ascending aorta (AAo), aortic arch, distal to the coarctation, and descending aorta (DAo) (Figure 1A). For flow quantification, nine 2D planes were placed along the aorta. Regional net flow was determined by averaging the 2D plane flows by region. The ratio between DAo to AAo (DAo/AAo) net flow was used to assess collateral flow. Results: Velocities were generally higher and more consistent across the aorta following surgery (Figure 1A). Plots highlighting changes in DAo/AAo flow ratio are shown in Figure 1B. Compared to controls, DAo/AAo flow ratio was significantly lower prior to COA repair (0.38±0.11 vs 0.61±0.05, p = 0.0004), indicating flow obstruction at the COA and presence of substantial collateral flow. Post COA repair DAo/AAo flow ratio was similar compared to age matched controls (0.59±0.06 vs 0.61±0.05, p = 0.51), indicating normalization of aortic flow. Patient 2, who underwent COA repair via stent placement showed the greatest improvement and normalization of flow consistency (DAo/AAo) across the aorta after intervention. Conclusion: A ortic 4D flow MRI shows normalization of aortic flow velocities, decreased collateral flow following COA repair, and has potential for long term surveillance and quantification of pre- and post-COA repair hemodynamic changes in children.
Abstract 11623: Retrograde Facilitated Antegrade Dissection and Re-Entry
Authors: Judit Karacsonyi, Bahadir Simsek, Spyridon Kostantinis, Emmanouil S Brilakis
Journal: Circulation (2022)

History: A 69-year-old man presented with severe medically refractory stable angina and was referred for revascularization of a right coronary artery (RCA) chronic total occlusion (CTO Figure 1.A ). The patient had undergone coronary artery bypass surgery 16 years prior as well as numerous percutaneous coronary intervention. Echocardiography demonstrated normal left ventricular systolic function. Procedure: Antegrade wiring was attempted first with a Fielder XT guidewire (GW) and a Turnpike Spiral microcatheter (MC Figure 1.B ). Due to the ambiguous proximal cap and long occlusion length, retrograde crossing was attempted next. After attempting to cross multiple collaterals a Sion Black crossed a proximal septal collateral ( Figure 1.C ), but several MCs could not follow the GW, despite ballooning the collateral with a 1.5 mm balloon and GuideLiner support. We switched to antegrade dissection and re-entry with a knuckled Gladius Mongo that reached the distal RCA ( Figure 1.D ). With the Stingray balloon and ‘double blind stick and swap’ technique we crossed into the distal true lumen, but the GW position was lost after removal of the balloon. We crossed with the retrograde GW to the antegrade guide catheter (Figure 1.E) , but ‘tip in’ technique as well as passing the retrograde MC was not successful. Using a new Stingray balloon and the retrograde GW as true lumen marker ( Figure 1.F ) we crossed into the distal true lumen. After drug-eluting stent implantation ( Figure 1.G ) the distal bifurcation was recanalized with kissing balloon dilation ( Figure 1.H ) and implantation of another stent with a nice final result ( Figure 1.I ). Conclusion: Persistence is key in CTO PCI in patients with severe medically refractory stable angina and limited revascularization options. Crossing the collaterals with MC can be challenging: possible solutions are smaller MC, predilation in septal collateral, ‘tip in’ or switching to another crossing strategy such as ADR with retrograde facilitation.
Abstract 11446: Impact of Higher Synchronized Left Ventricular Pacing Rate for Prognosis on Cardiac Resynchronization Therapy
Authors: Yuichiro Miyazaki, kohei ishibashi, Nobuhiko Ueda, Akinori Wakamiya, Keiko Shimamoto, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Kengo Kusano
Journal: Circulation (2022)

Background: The adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular pacing (sLVP) to produce fusion with the intrinsic right ventricular activation in normal atrioventricular (AV) conduction. Although sLVP has benefits over biventricular pacing (BiV), the adequate sLVP rate for better clinical outcome is still unclear. Purpose: The aim of this study was to assess the association between sLVP rate and clinical outcome. Methods: Among our cohort of 271 consecutive patients who had CRT implantation between April 2016 and August 2021, we evaluated 63 CRT patients without considerably prolonged AV conduction to whom we applied the aCRT algorithm (48 males, mean age: 64±14 years old, and the median follow up period: 316 days [interquartile range: 212-809days]). Results: At follow-up 6 months after CRT implantation, the frequency of CRT responder was 71% (n=45). The sLVP rate was significantly higher in responder compared to non-responder (75±30 vs 47±40 %, p=0.003). Receiving operating characteristics (ROC) curve analysis revealed that optimal cut-off value during sLVP rate was 59.4% for prediction of CRT responder (an area under the curve: 0.70, sensitivity: 80%, specificity: 61%, positive predictive value: 84%, and negative predictive value: 55%). Kaplan-Meier analysis demonstrated that higher sLVP group (sLVP≥59.4%, n=43) had better prognosis (cardiac death and heart failure hospitalization) compared to lower sLVP group (sLVP&lt;59.4%, n=20) (log-rank p&lt;0.001) (Figure) and multivariate Cox hazard analysis revealed that higher rate was associated with good prognosis (p&lt;0.001). Conclusion: sLVP was associated with CRT response and higher sLVP rate (≥59.4%) may be important for good prognosis in patient with aCRT.
Abstract 11639: Effect of Diabetes Mellitus on Clinical Phenotype and Cardiovascular Mortality in Non-Ischaemic Dilated Cardiomyopathy
Authors: Daniel J Hammersley, Richard E Jones, Lukas Mach, Ruth Owen, Amrit S Lota, Zohya Khalique, Antonio de Marvao, Ankur Gulati, Resham Baruah, Kaushik Guha, James S Ware, John G Cleland, Dudley J Pennell, Brian P Halliday, Upasana Tayal, Sanjay K Prasad
Journal: Circulation (2022)

Introduction: Diabetes mellitus (DM) is common amongst patients with heart failure (HF) and associated with adverse outcomes. Historically this has been attributed to the association with atherosclerotic disease. We assessed the effect of DM on phenotype and outcomes in patients with non-ischaemic dilated cardiomyopathy (DCM). Methods: Prospective observational cohort study of 727 patients with DCM. All underwent a cardiac MRI and long-term follow up. The primary endpoint was CV death. Results: Of 727 patients with DCM (472 men, mean age 55 years, median LVEF 40%), 88 (12.1%) had DM at enrolment, of whom 19 (21.6%) were managed with insulin, 52 (59.0%) with oral hypoglycaemic agents (OHA) alone and 17 (19.3%) by diet alone. Enrolment predated guideline recommendations for SGLT2 inhibitors for HF. Patients with DM were older, had higher BMI, higher NYHA class, more were hypertensive and treated with loop diuretics (all p&lt;0.001), ACEi/ARB (p=0.02) and mineralocorticoid receptor antagonists (p=0.002). Compared to patients without DM, those with DM had lower LVEF (mean difference -4% [95%CI -7 to -1], p=0.007) and more had myocardial fibrosis (OR 1.81 [1.13 to 2.91] adjusted for age and sex). After median follow up 7.7 years, 71 patients died from CV causes. DM was associated with higher cumulative incidence of CV death on univariate analysis (log rank p&lt;0.001, Figure), but not after adjusting for age, sex, LVEF, NYHA, fibrosis, LAVi and RVEF (HR 1.66, 0.91 to 3.02, p=0.10). Patients with DM treated with insulin or OHA were at greater risk of CV death even after adjusting for the above variables (HR 2.02, 1.11 to 3.67, p=0.04). DM managed by diet alone was not associated with excess risk. Conclusions: DM is associated with adverse LV remodelling and fibrosis in patients with DCM; the subset requiring OHA or insulin had worse CV prognosis. Risk factor and lifestyle management may improve outcomes. Further studies are needed to assess whether added risk is attenuated by SGLT2 inhibitors.